International Journal of Trend in Scientific Research and Development (IJTSRD)

Volume 7 Issue 1, January-February 2023 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470

Henoch-Schönlein Purpura (HSP): Case Report

Dr. Thenmozhi. P1, Soumya. C2
1
Professor and HOD, Department of Medical and Surgical Nursing, Saveetha College of Nursing,
2
M.Sc (Nursing), Nurse Practitioner in Critical Care II Year, Saveetha College of Nursing,
1,2
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

ABSTRACT How to cite this paper: Dr. Thenmozhi.

An acute immunoglobulin A (IgA) - mediated condition known as P | Soumya. C "Henoch-Schönlein
Henoch-Schönlein purpura (HSP) is characterized by a widespread Purpura (HSP): Case Report" Published
vasculitis affecting the small blood vessels of the skin, GI tract, in International
Journal of Trend in
kidneys, joints, and, in rare cases, the lungs and central nervous
Scientific Research
system (CNS). Henoch-Schönlein purpura is characterized by the
and Development
"classic triad" of purpura, arthritis, and stomach pain. Antigen- (ijtsrd), ISSN:
antibody (IgA) complexes activate the alternative complement 2456-6470,
pathway in this systemic illness, causing inflammation and small Volume-7 | Issue-1, IJTSRD52705
vessel vasculitis. Mild illness resolves on its own, and February 2023,
symptomatic treatment is all that is required. For HSP that ranges pp.440-442, URL:
from mild to severe, systemic steroids are advised. The level of www.ijtsrd.com/papers/ijtsrd52705.pdf
renal involvement affects the prognosis, thus close monitoring is
necessary. Early detection - as in the case of our adolescent Copyright © 2023 by author (s) and
patient—and the right kind of management can help to slow the International Journal of Trend in
progression of the illness and prevent organ damage. Scientific Research and Development
Journal. This is an
KEYWORDS: Henoch-Schönlein purpura (HSP), IgA vasculitis, Open Access article
steroids distributed under the
terms of the Creative Commons
Attribution License (CC BY 4.0)
(http://creativecommons.org/licenses/by/4.0)

INTRODUCTION
IgA vasculitis, also known as Henoch-Schönlein
purpura (HSP), is a condition that most frequently
affects children and affects the skin, mucous
membranes, and occasionally other organs. The
illness results in palpable purpura (small, elevated
spots of blood beneath the skin), which frequently
coexists with joint and gastrointestinal pain- the
“classic triad “. Small amounts of blood and protein
may be lost in the urine as a result of renal
involvement (hematuria and proteinuria), although
this usually remains undetected; in a small percentage
of instances, the kidney involvement progresses to
chronic kidney disease. The illness was first
documented in the 1860s by Johann Lukas Schönlein
(1793–1864), a teacher of Eduard Heinrich Henoch
(1820–1910), a German pediatrician. Henoch was
also responsible for its naming. Schönlein and
Henoch correlated the purpura to arthritic
involvement, while Henoch related the purpura to
gastrointestinal issues. William Osler was the first to
recognize the underlying allergic mechanism of HSP.
It occurs more often in children than in adults, and
usually follows an upper respiratory tract infection.
The most prevalent form of vasculitis in children is
HSP, which has a frequency of roughly 20 per
100,000 children each year. Based on the
constellation of symptoms, a diagnosis is established.
Blood tests may show elevated creatinine and urea
levels (in kidney involvement), raised IgA levels, and
raised C-reactive protein (CRP) or erythrocyte
sedimentation rate (ESR) results. It can be
distinguished from conditions where low platelet
counts are the origin of the purpura, such as
idiopathic thrombocytopenic purpura and thrombotic
thrombocytopenic purpura, by the possibility of an
increased platelet count.
We report a unique case of Henoch–Schönlein
purpura, a 14-year-old male.
Case description
A 14-year-old adolescent male presented with fever
and sore throat for 3 days. He was initially given oral
antibiotics. Within a day, he began to experience an
erythematous, non-pruritic rash that spread from his
feet to his thighs, upper limbs, and involving his
palms and soles. Later, the feet became swollen and

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 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
had moderately severe (7/10) intense pain that was Fig: 3
made worse by walking. On physical examination,
there was pharyngeal erythema, petechiae on the soft
palate, cervical lymphadenopathy, a nodular, and
non-tender, non-blanching purpuric rash involving
both upper and lower extremities with non-pitting
pedal edema (Figures 1 and 2). Two days later, the
patient experienced right and left upper quadrant
abdomen pain that was persistent, colicky in nature, Figure 3 - Endoscopic findings showing
8/10 in intensity, and made it worse after eating and inflammation, submucosal hemorrhage and
associated with hematemesis and watery stools. ulceration.
Laboratory tests showed leukocytosis (WBC:
18,700); Hb: 13.5 g/dL; Hct: 41.2%; BUN: 17 mg/dL;
Serum Creatinine: 0.8 mg/dL; Urinalysis: no
hematuria or proteinuria; ESR: 58 mm/Hr; CRP:
6.1 mg/dL; Antistreptolysin O titer: 823 IU/L; ANA:
Negative; EBV-VCA IgM: Negative; Anti-HAV
IgM: Negative; HbsAg: Negative; Anti-HBc IgG:
Negative; Mono spot test: Negative; c-ANCA: 0.2 Fig: 4 Small bowel biopsy showing neutrophilic
units; p-ANCA: 0.2 units; Stool for occult blood: and eosinophilic
positive. Multiple erosions in the duodenum and
antrum were visible during esophagogastroduo-
denoscopy (Figure 3). The small bowel's
histopathology (Figures 4 and 5) revealed intact
villous architecture, neutrophilic and eosinophilic
infiltrates, and leukocytoclastic vasculitis. There was
no evidence of epithelioid granuloma. Colonoscopy Fig:5 Histopathology of small bowel showing
showed erythema and inflammation in the terminal micro abscess infiltrates
ileum and cecum. Cecal biopsy also showed
leukocytoclastic vasculitis. A skin biopsy revealed
pustular leukocytoclastic fibrinoid vasculitis with a
micro abscess (Figure 6). The patient was diagnosed
with Henoch-Schönlein purpura. He was treated with
intravenous fluids. He was started on oral prednisone
20 mg twice a day, with resolution of his symptoms
and a decrease in ESR and CRP. Fig: 6 Histopathology of skin
Discussion
An uncommon inflammatory condition of the small
blood vessels (capillaries), Henoch-Schönlein purpura
(HSP) is typically a self-limited condition. It causes
inflammatory alterations in the tiny blood vessels and
is the most prevalent type of juvenile vascular
inflammation (vasculitis). Headache, fever, loss of
Fig: 1 appetite, cramping, abdominal pain, hives, bloody
diarrhea, and joint pain are among the symptoms of
HSP that typically start out unexpectedly. Typically,
red or purple blotches will form on the skin
(petechiae). Joints, kidneys, the digestive system, and,
in rare instances, the brain and spinal cord can also
experience HSP-related inflammatory alterations.
Although the precise origin of HSP is unknown,
evidence suggests that immune system malfunction
Fig: 2 may be a contributing factor (i.e., increased IgA
Figure 1 & 2 showing clinical picture of palpable immune complexes). It could be challenging to
purpura involvement of upper and lower diagnose HSP. Skin lesions and/or joint discomfort,
extremities

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in addition to laboratory tests, skin biopsies, and other
factors are used to diagnose the condition. There is no
specific treatment, although the majority of patients
experience a short course of the condition, which
gives them a fair chance of recovering. Some patients
may receive treatment with glucocorticoids (steroid
medications) if non-steroid anti-inflammatories are
unable to improve symptoms.
Conclusion
With respect to the patient’s clinical, laboratory tests
and histopathology findings, patient was treated with
Intravenous fluids and oral prednisone. The main aim
of the treatment is to prevent multiorgan involvement.
Prompt diagnosis and multidisciplinary intervention
can lead to appropriate management and mitigate
potential complications, as illustrated in this case.
Conflict of Interest
None
Funding
None
Consent for publication
Informed consent was obtained from the parents of
the patients to publish this case in medical journal.
@ IJTSRD | Unique Paper ID – IJTSRD52705 | Volume – 7 | Issue – 1 | January-February 2023
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